If you ask chiropractors across the country to name one of the biggest problems they are facing, it’ll most likely have to do with collections – either they’re dwindling, or have remained flat for a long period of time. We get it.

Our job is to help chiropractors increase collections while providing expert insurance billing services, so we know how complicated it can seem. Fortunately, we have some specific suggestions that will help you improve collections, particularly from cash patients, Medicare, personal injury carriers and regular insurance.

Chart Notes

The quality of your patient notes can directly affect your reimbursements. The first step to improving them is to make sure your notes are legible. That’s why all-in-one chiropractic software is so valuable – it includes intuitive notes, charting and guided documentation which results in fewer errors. It also takes away the guesswork at deciphering handwriting.

Secondly, you’ll need to establish a chiropractic treatment plan for each patient, and reflect evidence of functional improvement within the chart notes. Making sure your documentation is in compliance will increase reimbursements; here are the key areas that will help.  

  • Conduct regular re-exams – this will establish medical necessity and conversion to wellness or maintenance care.
  • Record specific levels of subluxations treated.
  • Record progress towards goals.
  • Provide planned re-evaluations.
  • Include a valid signature that services were performed.
  • Have a “notice of privacy practices” form for every patient; for minors, have a “consent-to-treat-minor” form on file.
  • Track and record the time spent in therapy (and for each exercise).
  • Supply worksheets to your patients indicating the specific exercises completed.


One of the most cost effective ways to increase collections is by improving coding. Unfortunately, it isn’t easy to stay current with coding, and this can result in reduced reimbursement, or delayed and denied claims.

Some chiropractors intentionally undercode in order to avoid the penalties associated with overcoding or unbundling. Others leave the coding to their administrative staff, which can be so confusing and complicated that it results in an even higher rate of errors, and an increased level of stress.  

Properly documenting an exam for purposes of correct coding and billing isn’t something that is extensively taught in school, so coding continues to be a problem for practices everywhere. One solution is to invest in regular coding classes. Another is to partner with chiropractic insurance billing experts who can monitor payer habits, coding, rules and trends across the nation to ensure immediate client billing.

Getting paid

When it comes to insurance, personal injury and cash payments, have a detailed financial policy in place. The majority of your patients will have some sort of insurance that covers chiropractic, so for insurance reimbursement, call to verify coverage prior to submitting bills.

As for prepaid plans, they’re great as long as they’re within your state’s scope of practice. Some states allow prepays, but be aware that there might be limitations. To cover your bases, here are some precautions you can take:

  • Have patients sign a form acknowledging that certain portions of their care may not be covered by insurance.
  • Patients must understand and agree to pay for all services and products at the time they are provided.
  • Give patients ample opportunity to ask questions about their financial obligation, other treatment options, and their right to refuse care.
  • Have clear office procedures that include asking for payment before or immediately after the patient’s visit.


Do you know what constitutes “medical necessity?” According to the Centers for Medicare and Medicaid Services (CMS), medical necessity is:

“… a service, treatment, procedure, equipment, or supply provided by a physician or other healthcare provider who is required to identify or treat a patient’s illness or injury and which is: a) consistent with the symptom(s) or diagnosis and treatment of the patient’s illness or injury; b) appropriate under the standards of acceptable practice to treat that illness or injury; c) not solely for  the convenience of the participant, physician, or other healthcare provider; and d) the most appropriate service, treatment, procedure, equipment, or supply that can be safely provided to the patient and accomplishes the desired end result in the most economical manner.”

Always respond to and appeal improper denials, especially on medical necessity. If you’re getting denials based on the patient reaching maximum medical improvement, compose an effective appeal letter.

The American Chiropractic Association (ACA) states that, “… it is vitally important to the chiropractic profession and your patients that you appeal all denials, whether they are pre-service restrictions, restrictions of continued care, or down-coded and bundled claims.” For appeal resources and samples of appeal letters, visit the ACA website.

ACOM Health